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CAIRNS 2013

ICAK INTERNATIONAL CONFERENCE

19 21 April 2013

Cairns Convention Centre, QLD

Australia
Pre Conference Workshop
with Dr Richard Belli
Neurological Applications of AK

ICAK International Conference 2013, Australia

Neurological applications of AK

8/04/13'

Richard Belli, DC, DACNB, FABNN

Neurological'Applica4ons'of'Applied'
Kinesiology'Preconference'Workshop'
Cairns'Australia''
Richard'Belli'D.C.,'D.A.C.N.B.,'F.A.B.N.N.''

This%Sums%It%UP%
With'few'excep4ons,'all'ac4vi4es'of'the'CNS,'
receiving,'processing,'and'integra4ng'informa4on,'
ul4mately'nds'expression'in'contrac4on'of'a'muscle.'
'

Color'Atlas'of'Physiology,'A.'Despopoulos,'S.'Silberange,'Year'
Book'Medical'Publishers,'Georg'Thieme'Verlag'

Ventral%Horn%Theory%and%
Manual%Muscle%Tes9ng%
All'muscle'tes4ng'ul4mately'tests'the'central'
integra4ve'state'of'the'Ventral'horn'
Determined'by'sum'total'eect'of'synap4c'ac4vity''
both'excitatory'and'inhibitory'

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The%Final%Common%Pathway,%Sherrington%

Brain%Based%AK%
The'brain'is'the'control'
center'for'all'major'
physiological'func4ons'
Very'dicult'to''x'
physiology'without'
xing'the'brain'

Important%Concepts%of%Muscle%Inhibi9on%%
Three%types%of'muscle'inhibi4on'
What'a'single'muscle'inhibi4on'really'means'
We'are'looking'at'muscle'inhibi4on'paGerns%vs.%
single%inhibi9on%

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Three%Muscle%Inhibi9on%Types%
Type%I:'Doctor'started'eccentric'test'with'no'preY
loading'
Type%II:%Pa4ent'started'eccentric'test'with'preYload'
to'maximal'isometric'contrac4on'
Type%III:%Pa4ent'started'with'submaximal'contrac4on'
is'a'preYloading'of'submaximal'concentric'
contrac4on'followed'by'an'eccentric'test'

Three%Muscle%Inhibi9on%Types%Contd.%
Type%I:%Doctor%started%(eccentric)'tes4ng'likely'recruits'
primarily'smaller'cells,'gamma'motor'neurons'ini4ates'muscle'
contrac4on'via'the'servomechanism'of'the'gamma'loop'
Type%II:%Pa9ent%started%to%maximum%(isometric'to'eccentric)'
tes4ng'recruits'the'largest'phasic'alphaYmotor'neurons'which'
innervate'primary'white'muscle'bers'
Type%III:%Pa9ent%started%submaximal%(concentric'to'eccentric)'
tes4ng'also'recruits'the'tonic'alphaYmotor'neurons'which'
innervate'primary'red'muscle'bers'

Neurology%of%Injury%Recall%Technique%
IRT'originated'by'Robert'Cro]y'DPM'
IRT'was'taught'to'Wally'Schmi]'Dc,'DIBAK,'DACNB'
by'Gordon'Bronston'DPM'
Wally'then'rened'the'technique''

Clinical'ndings'of'IRT'are'associated%to%cerebellar%
adapta9on%and%habitua9on%to'areas'of'injury'and'
trauma'
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Neurology%of%IRT%Contd.%
Three'major'sensory'inputs'for'postural'control'are'
eyes,'ves4bular'mechanism,'and'mechanoreceptors'
from'the'ankle'joint'
'

Postural'adapta4ons'depend'on'cerebellar'
integra4on'of'all'three'areas'
'

The'most'important'mechanoreceptor'inputs'to'the'
cerebellum'arise'from'muscle'spindle'aerents'

IRT%Neurology%Contd.%
Injury'results'in'numerous'altera4ons'in'stretch'
reexes'as'they'adapt'to'exor'reex'aerents'that'
arise'from'nociceptors'
Secondary'eects'of'nocicep4on'become'the'new'
normal'as'the'pa4ent'adapts'to'the'trauma''
If'the'trauma'is'signicant'enough'an'adapta4on'to'
cerebellar'modula4on'of'stretch'reexes'becomes'
the'new'normal''

IRT%Neurology%Contd.'
Synthesis'of'local,'cerebellar,'and'cor4cocerebellar'
adapta4ons'creates'an'altera4on'in'posture'
reected'as'an'ankle'or'neck'propriocep4ve'
adapta4on'to'the'injury''
Firing'muscle'spindle'bundles'of'the'muscles'associated'to'
the'ankle'joint'and'upper'cervical'spine'reset'
propriocep4ve'adapta4ons'

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IRT%Procedure%
Perform'distal'trac4on'micromanipula4on'of'the'
talus'(in'direc4on'of'opening'mor4se'joint)'or'
forward'rocking'of'the'atlantoYoccipital'joint'while'
simultaneously'performing'the'following'
Pa4ent'touches'are'of'previous'trauma'or'dysfunc4on''
Or'doctor'creates'mild'irrita4on'by'pinching'area'of'
previous'trauma'or'dysfunc4on'

''

New%Concepts%in%IRT%
Brain'IRT'
Brain'stem'IRT'
Spinal'cord'IRT'

Brain%VRPs%Correspond%to%Func9onal%Areas'

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Spinal%Cord%and%Brain%Stem%
IRT%Areas%%
Brain'stem:'
Located'between'external'occipital'protuberance'and'CY1'

Spinal'cord:'
Located'between'TY1'and'TY3,'TY10'and'TY12''

Brain%Stem%VRP%

'
Spinal%Cord%VRPs%
%

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Gait%Tes9ng%
Normal'gait'inhibi4on'and'facilita4on'pa]erns'are'
disrupted'by'posi4ve'therapy'localiza4on'
Under'many'therapy'localiza4on'circumstances'gait%
tes9ng%is%more%sensi9ve%than'the'neutral'posi4on'
Gait'tes4ng'is'more'sensi4ve'because%it%accesses%
primi9ve%nuclei%

Gait'is'generated%by%paGern%generators%in'the'
mesencephalon,'pon4ne'and'medullary're4cular'
forma4ons'as'well'as'the'spinal'cord'
Gait'pa]erns'are'coordinated%in%the%mesencephalon%
Gait'is%modulated%by%the%basal%ganglia,%cerebellum%
and%spinal%cord%

Primi4ve'cerebellar'and'pon4ne'nuclei'are'in4mately'
associated'with'the'hypothalamus'and're4cular'
forma4on'to'modulate'movement'mediated'
metabolic'func4on'
Structural'or'chemical'changes'that'alter'the'
func4on'of'these'nuclei'will'be'expressed'as'
altera4ons'of'the'normal'inhibi4on'and'facilita4on'
pa]erns'of'primi4ve'movement'(gait)'

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First%Things%FirstSTLR/TNR%
TLR/TNR'rst'because'dysfunc4on'masks%paGerns%
The'TLR'is'not'strong'enough'to'create'muscle'tes4ng'
inhibi4on,'but'is'powerful'enough'in'excitatory'eects'to'
overcome'many'other'sources'of'inhibi4on'hiding'other'
pa]erns''

Oers'rst'opportunity'to'address'IRT,'Inamma4on,'
and'pain'pathways'

TLR/TNR%PaGerns%Related%to%Head%Posi9on%
TLR/TNR'create'pa]erns'of'excita4on'and'inhibi4on'
of'the'limbs'helping'to'maintain'upright'posture'or'
to'catch'the'body'in'case'of'a'fall'
In'the'supine'posi4on'the'right'ear'down'facilitates'
the'right'limb'extensors'and'inhibits'of'the'right'limb'
exors'
Addi4onally,'the'same'head'posi4on'facilitates'the'
leh'sided'limb'exors'and'inhibits'of'the'leh'limb'
extensors'
Opposite'with'leh'ear'down'

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Reciprocal%Inhibi9on%
Reciprocal'inhibi4on'important'for:'
Respira4on'
Locomo4on'
Walking,'running'

Signicant'switching'factor'
Necessary'to'iden4fy'pyramidal'pa]ern'

If%You%Have%Normal%Reciprocal%Inhibi9on%

If%you%Dont%Have%Normal%Reciprocal%Inhibi9on%

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Reciprocal% Inhibi9on% is% a% Complex% Interplay% of% Spinal%
Cord%Interneurons%and%Descending%Modula9on%

Reciprocal%Inhibi9on%is%a%Complex%System%'
Of'spinal'cord'Ia'inhibitory'interneuron'func4on'and'
Renshaw'cell'func4on'coupled'with'brain'stem'and'
cor4cal'modula4on'

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Ia%Inhibitory%Interneuron%

Renshaw%Cells'
Are'inhibitory'interneurons'found'in'the'gray'ma]er'
of'the'spinal'cord'
They'are''associated'in'two'ways'with'alpha'motor'
neurons'
They'receive'an'excitatory'collateral'from'the'alpha'
neuron's'axon'as'it'emerges'from'the'motor'root,'thus'
"kept'informed"'of'how'vigorously'that'neuron'is'ring'
They'send'an'inhibitory'axon'to'synapse'with'the'cell'body'
of'the'ini4al'alpha'neuron'and/or'other'alpha'motor'
neurons'of'the'same'motor'pool'

Alpha%Motor%Neuron%Recurrent%Fiber%to%Renshaw%
Cell%and%Inhibitory%Collateral%
%to%Alpha%Motor%%Neuron%

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Renshaw%Cells%Inhibit%Inhibitory%Interneurons%

Descending%Spinal%Cord%Nerves%
Regulate%Renshaw%Cells%Via%PaGern%Generators%

Summary%of%Reciprocal%Inhibi9on%NTs'
Primi4ve'reexes'are'modulated'at'the'spinal'cord'
and'brain'stem'by'GABA,'glycine,'acetylcholine'and'
serotonin''
Renshaw'cells'are'modulated'by'glycine'
Ia'inhibitory'interneurons'are'GABAergic'

At'the'supraspinal'level'by'serotonin'and'
norepinephrine''
Modulatory'neurotransmi]ers'are'under'the'
inuence'physiological'factors'such'as,'hormones,'
prostaglandins,'interleukins,'cytokines,'ATP,'and'
insulin'

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Interneurons%and%Hormones%
Spinal'cord'interneurons'are'very'sensi4ve'to'
modula4on'by:'
Cor4sol'
Insulin'
Reproduc4ve'hormones'
Thyroid'hormones'
Inamma4on''

Interneurons%and%Inamma9on%
Spinal'cord'interneurons'are'very'sensi4ve'to'
inammatory'mediators'such'as:'
Prostaglandins'
Leukotrienes'
NFYkB'
ILY6'
TNFa'
ILY1'

%
Spinal%Cord%VRPs%
%

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Brain%Stem%VRP%

Reciprocal%Inhibi9on%Indicator%Test%
Indicated'by'contralateral'upper'and'lower'body'
exor'inhibi4on'when'tested'simultaneously'
'Quadriceps'and'opposite'pecYclavicular'

NonScanalized%Nervous%System%

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Canalized%Pathway%

NonScanalized%(Astrocytes%&%Microglia)%

Glial%Cells%in%the%CNS%
Oligodendrocytes'
'Wrap'axons'in'myelin'
'Ependymal'cells'
'Line'ventricles'
'Produce'cerebrospinal'uid'
'Astrocytes'
'Microglia'

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Ac9vity%of%Microglia%and%Astrocytes'

Glial%Cells%Deserve%More%Respect%
'

There'are'ten%glial%cells%for%every%neuron%
Fihy'percent'of'brain'mass'is'made'up'by'glial'cells'
Glial'cells'are'not'just'glue,'they'deserve'more'
respect''

Our%Focus%Today%is%Microglia%
%and%Astrocytes%
Astrocytes'
Blood'brain'barrier'
Regulate'synap4c'communica4on'
Neuronal'repair'
Contribute'to'control'or'circadian'rhythms'
Microglia'
Immune'
Neuronal'repair'
Modulate'synap4c'ac4vity'
Aect'brain'signaling'

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Astrocytes%and%the%Blood%Brain%Barrier%

Astrocyte%Physiology%
'

Astrocytes%are'star'shaped'glial'cells'in'the'brain'and'
spinal'cord'that'form%the%BBB%with%endothelial%cells%
Astrocytes'are'metabolically'very'ac4ve,'they'
provide'adjacent'neurons%with%nutrients%such'as'
glucose'and'ATP'
Astrocytes'have'the'ability'to'secrete'and'reuptake'
NTs'such'as'glutamate'and'GABA'
'

Astrocytes'are'very'important'for'neuronal'repair'

Astrocytes%release%ATP%and'regulatory'proteins'
necessary'for'myelina4on
'

'

Astrocytes'are'the'only'cells'in'the'brain'with%insulin%
receptors
%

'

Astrocytes%regulate%what%substances%from'the'blood'
reach%neurons%
'

Astrocytes'also'regulate%synap9c%communica9on'
among'neurons'

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Blood%Brain%Barrier%
The'BBB'is'a'membrane'structure'composed'of'
endothelial'cells'surrounded'by'astrocyte%
projec9ons%around%brain%capillaries%
'

The'blood'brain'barrier'maintains'CNS'homeostasis'
by'allowing'chemicals'necessary'for'brain'func4on'to'
cross'and'preven9ng%entry%of%substances%that%may%
alter%or%harm%neuronal%func9on%

Blood%Brain%Barrier%

Blood%Brain%Barrier%
The'structural'composi4on'of'the'BBB%easily%allows%
entry%of%oxygen,%CO2,%faGy%acids,%ethanol%and%steroid%
hormones%
'

Certain'amino%acids%and%sugars%may%also%cross%the%BBB%
necessary'for'energy'metabolism'and'NT'synthesis'
'

NTs%do%not%cross%the%BBB%with'the'excep4on'of'NE'and'
Epinephrine'at'the'hypothalamus'
'

The%BBB%restrains%B%cell%entry%and'protects'the'brain'
from'infec4on'

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Blood%Brain%Barrier%and%Inltra9on'
'

Loss%of%BBB%integrity%may%lead%to%a%
neuroinammatory%response%by'inltra4on'of'
Environmental'compounds'(haptens)''
Dietary'proteins''
Pathogenic'organisms'(an4gens)'

Blood%Brain%Barrier%and%Inamma9on%
'

Ac4va4on'of'GALT'or'BALT'by'pathogenic'organisms'
or'large'environmental'compounds'from'a'leaky'gut'
or'lung'syndrome'will'create'a'systemic%
inammatory%response%
'

The'inammatory'response'may'change'the'tone'of'the'
en4re'immune'system'and'promote'inamma4on'that'
may'degrade%the%BBB%

'Hormonal%Control%of%the%Blood%Brain%Barrier%
'

The'BBB'is'under'hormonal'control%of%the%HPA%axis%
%

The'BBB%looses%its%integrity%during%9mes%of%stress%
as'a'consequence'of'cor4sol,'cytokines'and'other'
stress'physiology'messengers'
'

Studies'show'that'dampening%of%HPA%axis%restores%
BBB%%
'

Therefore'modula9on%of%HPA%axis%is%important%for'''
BBB'integrity'
'

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BloodSBrainSBarrier%
DEGRADE%
Elevated'Homocysteine'
Increased'Oxida4ve'Stress'
Physiological'Stress'
Response'
HPA'Axis'Dysregula4on'
Alcohol'
Glycosylated'End'Products''

ENHANCE%

Methyla4on'Physiology'
Modulate'Stress'Physiology'
HPA'Axis'Regula4on'
AlphaYLipoic'Acid'
Glutathione'
An4oxidants'
Brain'Neuronal'Ac4vity'
Prostaglandin'Balance'

Microglia%Are%The%Immune%System%of%The%Brain%

Microglia%Physiology%
Microglia'account'for'20%'of'the'total'glial'cell'
popula4on'within'the'brain
'

'

Macrophages'in'the'peripheral'NS'and'microglia'in'
the'brain'are'very'similar'in'func4on'
'

They'are'both'used'to'iden9fy%an9gens%and%use%
phagocyte%and%cytotoxic%mechanisms%to%destroy%
foreign%material%
'

Microglia'are'constantly'circula4ng'throughout'the'
CNS'surveying'and'scavenging'for'immunological'
opportuni4es'
'

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B%cells%do%not%cross%the%BBB%so'protec4on'by'
microglia'is'cri4cal'
'

Microglia'cell'ac4va4on'occurs'when'there'is'a'
poten4al'threat'to'the'safety'of'neural'4ssue'
'

Since'the'brain'is'so'sensi4ve'to'injury'microglia%cells%
must%account%for%both%ac9ve%and%immediate%
immune%responses
%

'

Inammatory%responses%in%the%peripheral%immune%
system%(especially'GI'and'respiratory'tract')'may'
promote'and'trigger%microglial%inammatory%
responses%%%
Compounds'such'as'cytokines,'TYcells,'and'
lipopolysaccharides'all'cross'the'BBB'
Therefore'up'regula4on'of'the'immune'system'outside'
the'CNS'has'poten4al'to'increase'the'ac4va4on'of'
microglia'in'the'CNS'
'

'

'

Excitotoxic'proper4es'of'microglia'are'used'to'
destroy'bacteria'and'infected'neurons'
'

'

However'microglia'excitotoxic%%ac9vity%produces%severe'
amounts'of'collateral%damage%to'surrounding'neurons'

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%Microglia%Func9on%
'

Scavenging'
Phagocytosis'
Cytotoxicity'
An4gen'Presenta4on'
Synap4c'Stripping'
Extracellular'Signaling'
Promo4ng'Repair'

Microglia%Glia%are%Associated%With%%
Mood%Disorders%
'

The'immuneYbrain'connec4on'is'underappreciated'
and'of'clinical'importance'when'inves4ga4ng'
mechanisms'for'depression,'cogni4ve'decline,'and'
neurodegenera4on'
'

Neuroinamma9on'is'now'considered'one'of'the'main'
causes'of'depression%

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Summary%of%Pathways%We%Need%to%Address%
'

ATP%
Insulin%
Homocysteine%
Hormones'
EFA'metabolism'
Cor4sol'
Gut'and'lung'barriers'
Neurogenic'inamma4on'

ATP%Has%Many%Important%Roles%in%the%%
Central%Nervous%System%
ATP'provides'high%energy%phosphate%bonds%for'
cellular'energy'
'

ATP'modulates%communica9on%among%neurons%and'
between'neurons'and%glia%
'

ATP'and'its'breakdown'product'adenosine'is'also'
involved'in'sleep,'memory,'learning,'and'movement'
'

ATP'is'the'primary%NT%that%glial%cells%communicate%
with%

Common%Disruptors%of%Mitochondria%%%
'

Disruptors'of'the'mitochondria'include'anemia,'
inamma4on,'oxida4ve'stress,'deple4on'of'GSH'and'
SOD'
'

Nitric'oxide'from'inammatory'process'combines'
with'H2O2'to'form'peroxynitrate,'which'causes'
dysfunc4on'of'CAC'and'ETC'
'

Insucient'cofactors''such'as'Iron,'BYcomplex,'
manganese,'lipoic'acid,'magnesium,'and'Q10'
disrupts'CAC'ac4vity'

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Heavy%Metals%Block%CAC%
'

Heavy'metals'bond'to'any'available'sulphur'group'including'
lipoic'acid,'making'lipoic'acid'unavailable'for'CAC,'which'is'the'
source'of'heavy'metal'fa4gue'
'

Glutathione'metabolism'dysfunc4on'results'in'heavy'metal'
reten4on'
'

Glutathione'(GSH),'provides'the'major'intracellular'defense'
against'mercuryYinduced'neurotoxicity.'
ThimerosalYinduced'cytotoxicity'was'associated'with'deple4on'of'intracellular'GSH'in'
both'cell'lines.'Neurotoxicology.2005'Jan;26(1):1Y8.'PMID:'15527868below'

Glutathione%is%Our%Natural%Heavy%Metal%Chelator%
Binds'to'heavy'metals'for'elimina4on'
Binds'to'metal'ions'to'form'complete'ring'like'
structures'that'are'less'toxic'and'immune'reac4ve'
Prevents'oxida4ve'4ssue'destruc4on'form'metals'
Supports'immune'regula4on'
Protects'the'barrier'systems'

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Immune%Chemicals%Block%CAC%
'

In'the'presence'of'immune'stress'and/or'toxicity,'
cytokines'(ILY2,'TNFa)'increase'nitric'oxide'
'

NO'inhibits'cisYaconitate'enzyme'in'CAC'and'
uncouples'oxida4ve'phosphoryla4on'

CisSAconitate%Enzyme%

CO2%and%The%Re9cular%Forma9on%
Decreased'CAC'leads'to'decreased'CO2,'decreased'
CO2'leads'to'decreased'rostral're4cular'forma4on'
ac4vity,'leads'to'decreased'cor4cal'ac4vity'
Rostral're4cular'forma4on'is'ohen'referred'to'as'the'
re4cular'ac4va4ng'system'

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Prostaglandin%Balance%
'

Increased'proSinammatory%prostaglandins%cause%loss%of%
BBB%integrity'increasing'inammatory'cytokine'response'
promo4ng'dysregula4on'of'microglia'
'

Decreased%insulin%leads%to%deceased'DY6YD'ac4vity'decreasing'
conversion'of'linoleic'acid'to'GLA'and'EPA'resul4ng'in'loss%of%
membrane%integrity%
'

Increased%insulin%ac9vity%leads%to%increased'DY5YD'shihing'
FFAs'to'arachidonic'acid'leading'to%increased%inamma9on%
and%uncoupling%of%complexes%I%&%II%of%the%ETC%

Advanced%Glyca9on%End%Products%
'

Ages'are'destruc4ve'and'inammatory'to'many'
4ssues,'but'especially'to'vascular'epithelium'in'the'
brain'leading'to'compromise'of'the'BBB'

'

When'serum'glucose'levels'are'abnormally'high'and'
cannot'be'taken'into'the'cell'eec4vely'as'in'diabetes'or'
insulin'resistance'condi4ons,'the'glucose%in%the%%blood%
stream%becomes%oxidized%by%free%radicals%and'produces''
an'extremely'inammatory'compound'called'advanced%
glyca9on%end%products%or%AGES%

'
'

'

Elevated%Homocysteine%Increases%the%%
Brain%Immune%Response%in%Two%Ways%
%
%

First'it'promotes%loss%of%integrity%of%the%BBB%that'
leads'to'poten4al'crossing'of'pathogenic'organisms'
and'haptens''into'the'CNS'
'

Secondly,'elevated'Homocysteine'itself'has'been'
shown'to'promote%an%immune%response%due%to%
inammatory%proper9es%

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Altered%Methyla9on%and%%
Neurodegenera9ve%Disease%

79'

ILY1''''''''''''''''''''''''''TNFYa'''''''''''''''''''''''ILY2'
'''''''''''ILY2'''''''''''''''''''''''''''''''''''NFYkB'''''''''''''''''''''ILY6'
'
ILY4'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''IFN'
'
'
'

CRP
'

To%Bring%the%BBB%and%Glial%Cells%Back%to%Health%
We%Need%to:%

Normalize'mitochondrial'func4on'and'ATP'produc4on'
Fix'gut'and'lung'barriers'
Fix'essen4al'fa]y'acid'metabolism'
op4mize'Homocysteine'levels'
Regulate'hormones'
Normalize'BY12/folic'acid'
Control'cor4sol'
Regulate'insulin'and'glucose'metabolism'
Control'neurogenic'inamma4on'

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NonSCanalized%System%Inhibi9on%PaGern%
For'the'most'part'canalized'system'dysfunc4on''
presents'unilaterally'resul4ng'in'unilateral'inhibi4on'
pa]erns'
'

Therefore'bilateral'inhibi4on'of'supraspinatus'leaves'
us'with'nonYcanalized'system'dysfunc4on'
'

The''nonYcanalized'system'is'primarily'Glial'cells'

Supraspinatus%

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Brain%Reexes%

Heart%Neurolympha9c%
2nd%intercostal%space%near%sternum%

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Regulatory%B%Cells%

Three%Outcomes%of%Treatment%
Bilateral%supraspinatus%inhibi9on%will'be'cleared'
with'no'remaining'unilateral'pa]ern'
Unilateral%pa]ern'without%pyramidal%distribu4on'
Extra'Thalamic'Cor4cal'Modula4ng'System'
Unilateral%inhibi9on%with%pyramidal%distribu9on%
Inhibited'ipsilateral'nger'abductors,'wrist'
extensors,'shoulder'abductors,'hip'exors,'and'
great'toe'dorsiexors'
'

Evalua9ng%the%Extra%Thalamic%Cor9cal%%
Modula9ng%System%%
The'ETCMS'is'a'group'of'sub'cor4cal'nuclei'that'have'
projec4ons'to'virtually'all'cor4cal'neurons'
The%Extra%Thalamic%Cor9cal%Modula9ng%System%is%
actually'made'up'of'six%systems%arising'from'small'
nuclei'or'regions'of'the'brain'stem'and'forebrain'
which%project%neurons%directly%to%the%cerebral%
cortex%without%rst%synapsing%in%the%thalamus%
All'six'of'these'extra'thalamic'projec4on'systems'
appear'to'modulate'cor4cal'ac4vity,'hence,'the'term'
extra'thalamic'cor4cal'modula4ng'system '

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The%ETCMS%Provides%Chemical%Modula9on%of%the%Cortex,%in%Contrast,%
The%Re9cular%Ac9va9ng%System%Provides%%
Sensory%Modula9on%Through%the%Thalamus%

The%Nuclei%of%the%ETCMS%are%Major%Produc9on%Areas%
of%the%Involved%NeurotransmiGers%
Raphe'nuclei'(serotonin)'BY1'
Locus'ceruleus'(norepinephrine)'SIY19'
Mesencephalic'ventral'tegmental'area'(dopamine)'
GVY27'
Basal'nucleus'(acetylcholine)'GBY1'
Ventral'posterior'hypothalamus'(histamine)'STY1'
Caudal'hypothalamus'(GABA)'LIY20'

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Inamma9on%and%Tryptophan%

Degrada9on%of%tryptophan%through%the%Kynurenine%pathway%by%
indolamine%2,%3%dioxygenase%and%its%ac9va9on%by%highly%inducible%
proinammatory%cytokines%

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Indicator%for%Extra%Thalamic%Cor9cal%
Modula9ng%System%Involvement%
Unilateral'supraspinatus'inhibi4on'without'
pyramidal'pa]ern'
Unilateral'supraspinatus'inhibi4on'that'facilitates%
with%TL%to%mul9ple%B&E'points'on'the'head'

Voluntary%Lateral%Eye%Movements%or%%
Saccades%Disrupts%Gait%
%
Voluntary'lateral'eye'movement'involves'signicant'
cor4cal'ac4vity'especially'in'an'area'referred'to'as'
the'frontal'eye'elds'
Apparently'repeated'lateral'eye'movement'increases'
cor4cal'ac4vity'enough'to'challenge'for'adequate'
modula4on'from'the'ETCMS'
Lateral'eye'movement'disrupts'normal'inhibi4on'and'
facilita4on'pa]ern'of'the'gait'posi4on'
'

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%TL%to%One%Set%of%Head%Points%Will%Normalize%
Gait%Disrupted%by%Lateral%Eye%Movement%
Therapy'localiza4on'indicates'the'single'set'of'head'
points'that'need'to'be'treated'to'clear'TL'to'all'of'the'
head'B&E'points'and'normalize'gait'disrupted'by'
lateral'eye'movement''

Pyramidal%PaGern%of%Inhibi9on%

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What%is%the%Pyramidal%PaGern?%
A'distribu4on'of'inhibi9on%as%the%result%of%
decreased%descending%ipsilateral%cor9cal%ac9vity'
into'the'pontomedullary're4cular'forma4on'(PMRF)'
The'PMRF'normally'inhibits'upper'body'exors'
above%TS6'and'lower'body'extensors%below%TS6%
ipsilaterally%
If'normal'inhibi4on'of'upper'body'exors'and'lower'
body'extensors'does'not'take'place'you'get'reciprocal%
inhibi9on'of'upper'body'extensors'and'lower'body'
exors'

Misnomer%
Not%a'pyramidal'distribu4on'of'weakness%
Pyramidal'distribu9on%of%reciprocal%inhibi9on%
Or'hyperpolariza4on'of'the'extrapyramidal'tract'which'has'
lost'its'ability%to%perform%its%requisite%inhibitory%func9on%
which'modulates'pyramidal'inuences'

Therefore'the'pyramidal%distribu9on%is%the%result%of%
decreased%descending%cor9cospinal%projec9ons%into'
the'pontomedullary're4cular'forma4on'

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Pyramidal%Reciprocal%Inhibi9on%PaGern%
The'pontomedullary're4cular'forma4on'inhibits'
upper'body'exors'above'TY6'and'lower'body'
extensors'below'TY6'
Loss'of'PMRF'inhibi4on'leads'to'hyper'facilita4on'of'
exors'above'TY6'and'extensors'below'TY6'
Leading'to'reciprocal'inhibi4on'of'upper'body'extensors'
above'TY6'and'exors'below'TY6'

Simply:%ipsilateral%upper%body%extensor%inhibi9on%
and%lower%body%exor%inhibi9on%is%the%pyramidal%
paGern%

Why%Do%We%Need%the%Pyramidal%System?%
Increase'ipsilateral'an4gravity'support'
Increase'BP'and'fuel'delivery'to'opposite'or'working'
side'
Example:'
Right'arm'moves'when'leh'brain'res'
Increased'descending'ac4vity'to'ipsilateral'side'to'increase'
muscular'support'and'parasympathe4c'ac4vity'
Increase'IML'ac4vity'to'contralateral'side'shun4ng'fuel'in'
that'direc4on'

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Why%is%The%Pyramidal%Inhibi9on%
PaGern%Clinically%Important?%
Because'the'pyramidal'pa]ern'is'associated'to'
func4on'of:'
Cortex'
Basal'ganglia'
Thalamus'
Hypothalamus'
Brainstem'nuclei''

Hemisphere%Ac9va9on%
The'PMRF'inhibits'exors'and'extensors'for'postural'
integrity'and'resis4ng'gravity'
Results'in'a'general'increase'in'all'ipsilateral'muscle'
tone'as'well'as'increase'in'tone'of'upper'body'
extensors'and'lower'body'exors'

90%%of%Brain%Output%is%Through%
the%Pontomedullary%Re9cular%Forma9on%
Cortex'drives'the'PMRF'
PMRF'controls'the'autonomic'nervous'system'
PMRF'inhibits'the'IML'decreasing'sympathe4c'
output'
Only'10%'of'crossed'bers'are'associated'to'ne'
motor'movement''and'meaningful'distal'extremity'
ac4vity'

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The%Brain%and%Autonomic%Func9on%

Summary%of%Normal%Descending%%
Cor9cal%Ac9vity%

Increase'general'muscle'tone'ipsilaterally'
Increase'extensor'tone'above'TY6'
Increase'exor'tone'below'TY6'
Increase'PMRF'ipsilaterally'
Decrease'IML'ipsilaterally'
Increase'parasympathe4c'ac4vity'ipsilaterally'

PMRF%Has%Four%Basic%Outputs%
Inhibi4on'of'nocicep4on'at'the'dorsal'horn'of'the'
spinal'cord'ipsilaterally'
Ac4vates'all'ventral'horn'cells'ipsilaterally'by'
inhibi4ng'inhibi4on'
Inhibit'IML'ipsilaterally'
Inhibit'anterior'compartment'muscles'above'TY6'and'
inhibit'posterior'compartment'muscles'below'TY6'
ipsilaterally'

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The%PMRF%is%Primarily%%
Parasympathe9c%in%Nature%
The'dorsal'root'motor'nucleus'of'vagus,'nucleus'
tractus'solitarius,'superior'and'inferior'salivatory'
nucleus'
The'PMRF'res'caudally'and'ipsilaterally'to'the'IML'
of'the'en4re'spinal'cord'with'an'inhibitory'eect'

IML%is%Inhibited%by%the%PMRF%
%
The'IML'from'TY1'to'LY2'is'the'source'of'primary''
sympathe4c'nervous'system'ac4vity'
'for'the'en4re'body'
Ac4va4on'of'a'hemisphere'results'in'PS'ac4vity'
origina4ng'in'PMRF'and'an'inhibi4on'of'sympathe4c'
ac4vity'ipsilaterally'throughout'the'en4re'body'or'an'
overall'parasympathe4c'eect'ipsilateral'

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Example%of%Decreased%PMRF%or%%
Brain%Stem%Deciency%
Increased'sympathe4c'tone'ipsilaterally'
Increased'swea4ng'
Increased'blood'pressure'
Increased'vein'to'artery'ra4o'
Ipsilateral'migraines,'claudica4on,'varicosi4es'
Decreased'arm'swing'ipsilaterally'
Lean'to'contralateral'side'
Ipsilateral'pyramidal'pa]ern'

Brainstem%Deciency%Contd.%
Decreased'skin'temperature'
Arrhythmias'(LYAV)'Tachycardia'(RYSA)'
Large'pupil'''
Ipsilateral'pain'syndromes''
Global'ipsilateral'decrease'in'muscle'tone''
Flexion'deformity'of'upper'extremity''
Extension'deformity'of'lower'extremity''

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Too'Much'or'too'Li]le'Cor4sol'May'be'Associated'to'
Right'Hemisphere'Dysfunc4on'
%
Too'li]le'cor4sol'is'almost'always'is'a'right'brain'
decit''
Too'li]le'cor4sol'can'lead'to'autoimmune'diseases,'such'
as'allergies','asthma,'and'psoriasis'

Excess'cor4sol'can'reduce'immune'response'and'
result'in'chronic'colds,'infec4ons,'and'other'
condi4ons'of'viral'and'bacterial'invasions'

Immune'Response'can'be'Asymmetrically'Localized'
to'the'Leh'Side'of'the'Brain'
%
Resistance'tumors'from'Nk'cell'ac4vity'and'TYcell'
ac4vity'is'greater'in'the'leh'hemisphere'
Damage'to'the'leh'hemisphere'as'well'as'func4onal'
lesions'results'in'depression'of'NK'cells'and'TYcells'

Hemisphericity'and'Pain'

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Brain%Asymmetry%Leads%to%Unequal%
Sympathe9c%Output%and%Adrenal%Fa9gue%
With'good'cor4cal'func4on'IML'is'inhibited'un4l'
needed'for'survival'
With'failure'of'either'hemisphere'there'is'a'loss'of'
IML'inhibi4on'leading'to'increased'BP,'swea4ng,'
catecholamine'release'etc.'
This'constant'barrage'eventually'exhausts'the'
adrenal'glands'
Cor4cally'mediated'adrenal'fa4gue'

Areas%of%Lesion%

Cortex'
Basal'Ganglia'
Thalamus'
Cerebellum'

Lesion'does'not'necessarily'mean'damage'
Shih'towards'potassium'equilibrium'poten4al'

Areas%of%Lesion%

Cortex'
Thalamus'

Basal'ganglia'

Cerebellum'

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Causes%of%Dysfunc9on%

Deaerenta4on'
Inamma4on'
Autoimmunity'
Neurotransmi]er'dysfunc4on'
Hormonal'dysfunc4on'
Blood'sugar'issues'
Lack'of'ac4va4on'
Decreased'oxygen'

Pyramidal%Lesion%Summary%
C'

PMRF'

muscles'

BG'

T'

CB'

S'

SC'

Subluxa9onsSOensive%vs.%Defensive%
Oensive'subluxa4ons'cause'hemisphericity'
Defensive'subluxa4ons'try'to'correct'hemisphericity'
If'correc4ng'hemisphericity'by'other'means'makes'
subluxa4on'go'away'it'is''cor4cally'maintained'

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Increased%Rela9ve%Mesencephalon%
Leads'to'increased'red'nucleus'and'rubrospinal'tract'
tone'
Hypertonic'pectoralis'minor'
Autogenic'inhibi4on'will'not'inhibit'
Increased'TMJ'muscle'tone''

The%Brain%and%Survival%
The'right%brain%is'more'involved'with'responses''that'are'
key'to'survival%and%coping'with'stress'and'emo4onal'
situa4ons'
The'right%brain%also'regulates%arousal%
The'lei%brain%appears'to'be'most'important''in'defenses%%
against%invading%viruses%and%bacteria%
The'brains%eects%on%immune%func9on%occurs'through'
connec4ons'to'the'autonomic'system'and'hypothalamic'
(neuroendocrine)'feedback'systems'
Right%brain:%survival%and%TH2%
Lei%brain:%immune%and%TH1%

Commonly%Used%pyramidal%Muscle%Tests%

Ipsilateral'nger'abductors''
Ipsilateral'wrist'extensors''
Ipsilateral'shoulder'abductors'
Ipsilateral'hip'exors''
Ipsilateral'great'toe'dorsiexors'
Ipsilateral'supraspinatus'

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Correc9on%Modali9es%
Bilateral'K27'TL'facilitates'indicates'segmental'dysfunc4on'
Correct'with'segmental'IRT'or'manipula4on'

Thymus'TL'at'upper'sternum'facilitates'indicates'immune''
TYreg'or'BYreg'facilitates'indicates'autoimmune'
TYreg'or'BYreg'does'not'facilitate'indicates'inamma4on'
Correct'with'IRT'to'immune'CR'that'facilitates'

PTI'facilitates'indicates'one'of'the'following'
Gonad'CR'TL'indicates'hormone'involvement'
Correct'by'rubbing'or'IRT'to'involved'CR'

Pancreas'CR'TL'indicates'dysglycemia'

Correct'by'rubbing'or'IRT'of'involved'CR'

Thyroid'CR'TL'indicates'thyroid'involvement'
Correct'by'rubbing'or'IRT'to'involved'CR''

Cofactors'for'CAC'

Correct'with'brain'IRT'

Head'point'TL'indicates'neurotransmi]er'dysfunc4on'
Correct'by'trea4ng'head'point'

Ves9bular%System%

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The%Ves9bular%System%Has%Four%Main%Func9ons%
Sensa4on'and'percep4on'of'posi4on'and'mo4on''
Orien4ng'the'head'and'body'to'ver4cal'
Controlling'the'bodys'center'of'mass'
Stabilizing'the'head'during'postural'movements'

Pa9ents%With%Func9onal%Ves9bular%Disorders%May%
Present%With%Seemingly%Unrelated%Symptoms%
Neck'pain'
Back'pain'
Autonomic'dysfunc4on'
Balance'issues'
Issues'with'coordina4on'

Ves9bular%Apparatus%

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The%Human%Ves9bular%System%is%Made%up%of%Three%
Components%
A'peripheral'sensory'apparatus''
A'central'processor'
And'a'mechanism'for'motor'output'
'

Integra9on%of%the%Ves9bular%System%Takes%
Place%in%Mul9ple%Areas%
The'ves4bular'nuclei'
Areas'of'the'brain'stem're4cular'forma4on'
All'func4onal'areas'of'the'cerebellum'
Various'nuclei'of'the'thalamus'
Mul4ple'areas'of'the'cerebral'cortex''

The%Posterior%Insula%is%Considered%the%
Ves9bular%Cortex%

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'Output%of%the%ves9bular%System%Goes%to%Ocular%
Muscles%and%the%Spinal%Cord%to%Serve%%
Three%Important%Reexes%
The'ves4buloYocular'reex'(VOR)'
The'ves4bulocolic!reex'(VCR)'
The'ves4bulospinal'reex'(VSR)'

The'VOR'generates'eye'movements'that'enable'clear'
vision'while'the'head'is'in'mo4on'
'The'VCR'acts'on'the'neck'musculature'to'stabilize'
the'head'
The'VSR'generates'compensatory'body'movement'in'
order'to'maintain'head'and'postural'stability'and'
thereby'prevent'falls''

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In%the%Ves9bular%Nuclear%Complex,%Processing%of%
Ves9bular%Sensory%Input%Occurs%Concurrently%with%
Processing%of%Extra%Ves9bular%Sensory%Informa9on%%

Propriocep4ve'
Visual'
Tac4le'
Auditory'

Receptors%That%Provide%Informa9on%
%for%Postural%Control%
Proprioceptors'in'legs,'spine'and'neck'
Cutaneous'receptors'on'the'sole'of'the'foot'
Ves4bular'receptors'in'the'inner'ear'
Photoreceptors'in'the're4na'

The%Performance%of%the%VOR,%VCR,%and%VSR%is%
Monitored%by%the%Central%Nervous%System%
Readjusted'as'necessary'by'the'cerebellum,'and'
supplemented'by'slower'but'more'capable'higher'
cor4cal'processes'

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The%Ves9bular%System%is%Both%a%Motor%
%and%Sensory%System%
Output'neurons'of'the'VOR'are'the'motor'neurons'of'
the'ocular'motor'nuclei'complex'(CNs'III,'IV,'VI),'
which'drive'the'extra'ocular'muscles'
Output'neurons'of'the'VSR'are'the'anterior'horn'
cells'of'the'spinal'cord'gray'ma]er,'which'drives'
skeletal'muscles'''

The%%Ves9bulospinal%Tract,%Which%Comes%From%the%
Ves9bular%Nucleus,%Reaches%all%Levels%of%the%Cord%
'

The'lateral'ves4bulospinal'tract'adjusts'the'
contrac4on'of'muscles'that'oppose'the'force'of'
gravity'(an4gravity'muscles)'
The'medial'ves4bulospinal'tract'is'primarily'
important'for'media4on'of'reex'head'movements''

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As%a%Sensor%of%Gravity,%the%Ves9bular%System%is%One%of%
the%Nervous%Systems%Most%Important%Tools%to%
Control%Posture%
The'ves4bular'system'transforms'forces'associated'
with'head'accelera4on'and'gravity'into'electrical'
signals'that'travel'directly'to'motor'centers'for'
postural'and'ocular'stability'
Visual'and'propriocep4ve'reexes,'in'par4cular'must'
be'integrated'with'ves4bular'reexes'to'ensure'
postural'stability'

Each%Sensory%System%Contributes%Dierent%and%
Necessary%Informa9on%
The'visual'system'signals'the'posi4on'and'movement'
of'the'head'with'respect'to'surrounding'objects'
The'somatosensory'system'provides'informa4on'
about'the'posi4on'and'mo4on'of'the'body'with'
respect'to'the'support'surface'
The'posi4on'and'mo4on'of'body'segments'with'
respect'to'one'another'

Postural%Distor9ons%are%Ul9mately%the%Concomitance%
of%Changes%in%Muscle%Tone%and%Rela9onships%of%
Muscle%Groups%with%Each%Other%
Flexor'and'extensor'tonal'balance'may'be'disturbed'
When'the'biological'signals'from'the'ves4bular'
system'are'distorted'the'body'and'head'rela4onship'
to'gravity'is'distorted'
Shihs''in'center'of'gravity'
Postural'distor4ons'
Segmental'and'spinal'distor4ons'

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%
Ves9bular%System%Inhibi9on%and%Facilita9on%
PaGerns%are%Predictable%
%

When'movement'or'posi4onal'changes'are'made,'
normal'muscle'facilita4on'and'inhibi4on'pa]erns'
take'place'to'maintain'an'upright'posi4on'and'
balance'in'rela4onship'to'earths'gravita4onal'eld''

'
%Inhibi9on%and%Facilita9on%PaGerns%are%the%Result%of%%
Medial%and%Lateral%Ves9bulospinal%Tract%Func9on%
%
When'in'the'neutral'stance'posi4on'with'the'head'
4lted'back'axial'and'proximal'limb'extensors'are'
facilitated'and'exors'inhibited'
The'opposite'occurs'when'the'head'is'4lted'
forward'
When'the'head'is'4lted'to'one'side,'contralateral'
exors'are'inhibited'and'ipsilateral'extensors'are'
facilitated'

The%Semicircular%Canals%are%Associated%with%
Rota9onal%Movement,%the%Utricles%and%Saccules%are%
Associated%with%Linear%Movement%
When'tes4ng'is'done'in'the'sta9c%posi9on,'such'as'the'head'
4lted'back'or'forward,'the'emphasis'of'the'challenge'is'to'the'
otolith'func4on'in'the'utricles%and%saccules%
When'the'head'is'put'into'mo9on,'such'as'tes4ng'of'the'VOR,'
the'emphasis'of'the'challenge'is'on'the'semicircular%canals%
When'one'is'ambula9ng,%both%rota9onal%and%linear%forces%
are%involved;%therefore'both%semicircular%canals%and%the%
utricles%and%saccules%are%involved%

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Ves9bular%Summary%

Ves9bular%System%is%Easily%Evaluated%with%
Manual%Muscle%Tes9ng%
The'ves9bular%system%ul9mately%modulates%tone%
and%func9on%of%%large%groups%of%muscles,'lending'
itself'to'easy'and'ecient'evalua4on'with'manual'
muscle'tes4ng'
Both'medial'and'lateral'ves4bulospinal'systems'
are'associated'to'inhibi4on'and'facilita4on'of'
proximal'limb'and'axial'muscles'
''

Review%of%Muscle%Inhibi9on%%
and%Facilita9on%PaGerns%
The'following'mo4ons'involve'mostly'medial'ves4bulospinal'
tracts'
With'the'pa4ent'standing,'extension'of'the'neck,'or'4l4ng'
the'head'backwards,'should'normally'facilitate'extensors'
bilaterally'and'inhibit'exors'bilaterally'
Til4ng'the'head'towards'one'shoulder'should'facilitate'the'
ipsilateral'extensors'and'inhibit'the'contralateral'extensors'
Til4ng'the'head'forward'towards'the'chest'should'
facilitate'bilateral'exors'and'inhibit'bilateral'extensors'
The'following'mostly'involves'the'lateral'ves4bulospinal'tract'
Have'the'pa4ent'simply'touch'their'knees'then'stand'
upright'again,'which'should'normally'facilitate'bilateral'
axial'extensors'and'inhibit'bilateral'axial'exors''

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Correc9on%Modali9es%
If the normal facilitation and inhibition patterns of the
challenged systems do not take place, therapy
localization (TL) is done to identify areas of the nervous
system that may be involved
Once an area of dysfunction is localized, pinch and
rub modalities can be utilized to determine the
appropriate treatment modalities
If the area that TLs responds to rubbing, then injury
recall technique (IRT) is utilized
If the area responds to pinching, then
manipulation is utilized
If neither rub nor pinch normalizes the aberrant
pattern, rehabilitation exercises are utilized

Correc9ng%Ves9bulocerebellar%Loop%
Dysfunc9on%
The'ves4bular'system'u4lizes'informa4on'from'other'sensory'
modali4es'in'addi4on'to'the'ves4bular'mechanism'itself'
Removal'of'one'or'the'other'modali4es'puts'more'emphasis'
on'the'ves4bular'mechanism'itself''
With'the'eyes'closed'there'is'more'emphasis'put'on'input'
from'the'ves4bular'apparatus'and'its'inputs'into'the'
cerebellum'
Challenged'and'tested'by'having'the'pa4ent'stand'and'simply'
close'their'eyes'
If'the'ves4bular'mechanism'is'not'up'to'the'task'or'is'getng'
inappropriate'input'from'other'sensory'modali4es,'there'will'
be'condi4onal'inhibi4on'of'either'exors'or'extensors.''

Correc9ng%Medial%and%Lateral%Ves9bulospinal%
Tract%Dysfunc9on%%
The'lateral'ves4bulospinal'tract'receives'the'majority'
of'its'input'from'the'otoliths'of'the'saccule'and'
macula'and'the'cerebellum,'this'pathway'generates'
an4gravity'postural'motor'ac4vity''
The'vast'majority'of'bers'in'the'lateral'
ves4bulospinal'tract'originate'from'neurons'in'the'
lateral'ves4bular'nucleus'
The'tract'terminates'throughout'the'length'of'the'
cord,'either'directly'or'indirectly'on'anterior'horn'
cells'of'the'axial'and'proximal'limb'musculature'

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The'medial'ves4bulospinal'tract'mediates'ongoing'
postural'changes'or'head'righ4ng'in'response'to'
semicircular'canal'sensory'input''
The'medial'ves4bulospinal'tract'descends'only'
through'the'cervical'spinal'cord'in'the'medial'
longitudinal'fasciculus'and'ac4vates'cervical'axial'
musculature'
Neurons'in'the'medial'ves4bular'nucleus'receive'
aerent'bers'from'the'semicircular'canals'as'well'as'
from'the'ves4bular'cerebellum'

Correc9ng%Ves9buloSOcular%Reex%Dysfunc9on%
The'VOR'is'easily'tested'because'it'is'most'ac4ve'
during'normal'gait''
Addi4onally,'the'VOR'circuits'are'modulated'by'
cor4cal'ac4vity'
'

With'the'VORs'rela4onship'to'gait'and'the'cortex,'it'
lends'itself'to'tes4ng'using'brain'related'
supraspinatus'and'gait'inhibi4on/facilita4on'pa]erns'''

Indicator%of%VOR%Dysfunc9on%
Ves4buloYocular'dysfunc4on'is'iden4ed'by'putng'
the'pa4ent'in'the'standing'gait'posi4on,'having'them'
turn'their'head'slightly'opposite'the'forward'leg,'and'
looking'opposite'the'head'turn'with'their'eyes.'
If'this'posi4on'disrupts'the'normal'inhibi4on'and'
facilita4on'pa]ern'of'gait,'it'indicates'that'the'
VOR'is'dysfunc4onal'

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VOR%Challenge%Tests%
VOR'is'easily'challenged'by'having'the'pa4ent'focus'on'an'
object'such'as'the'examiners'nger'and'turn'the'head'side'to'
side'or'up'and'down'
Test'supraspinatus'
Test'gait'inhibi4on'and'facilita4on'pa]erns
If'the'pa4ent'is'tested'with'the'object'of'focus'far'enough'
away'that'the'eyes'do'not'converge,'the'tests'are'more'
specic'to'rota4onal'forces'and'the'semicircular'canals''
If'the'object'is'close'enough'to'converge'the'eyes,'the'mo4on'
is'more'linear'and'tests'more'of'the'utricle'and'saccule''
'

Ves9bular%Fixa9on%Exercises%
Ves4bular'xa4on'exercises'are'simply'done'by'
having'the'pa4ent'hold'their'thumbs'out'front'
placed'together'with'arms'extended.'
Star4ng'with'the'thumbs'in'the'center,'move'
them'to'one'side'while'moving'the'head'to'the'
opposite'side,'keeping'the'eyes'xed'on'the'
thumbs''
This'movement'is'done'in'both'direc4ons,'or'back'
and'forth,'for'about'one'minute,'or'un4l'fa4gue,'
three'4mes'a'day''

VOR%Cancella9on%Exercises%
Ves4buloYocular'cancella4on'exercises'are'done'by'
having'the'pa4ent'x'their'eyes'on'their'thumbs'
while'holding'them'together'out'front'with'arms'
extended'
Rota4ng'their'head'and'arms'from'the'center'to'
one'side'or'the'other'as'indicated'''
The'VOR'cancella4on'exercise'is'usually'done'to'
the'side'that'the'mastoid'process'therapy'
localizes''

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Neurological applications of Applied

Kinesiology flow chart
Richard Belli, DC, DACNB, FABNN

Tonic Labyrinthine and Neck Reflexes

In!supine!position!turn!head!and!test!pectoralis!major!clavicular!contralateral!to!head!turn6is!normally!
facilitated!in!types!I,!II,!&!III!
o If!normal!facilitation!does!not!occur!in!all!three!types!check!the!hypothalamic!pituitary!endocrine!
axis!and!gut!
If!glabella!TL!facilitates!perform!pituitary!drive!technique!
If!glabella!TL!does!not!facilitate!check!endocrine!and!immune!CRs!
If!endocrine!or!immune!CR!TL!facilitates!treat!with!IRT!or!rub!as!indicated!
If!none!of!the!above!facilitate!check!gut!CRs!
If!SI/LI!CR!TL!facilitates!treat!with!IRT!or!rub!as!indicated!
o If!normal!facilitation!does!not!occur!in!type!I!only!it!indicates!tonic!neck!reflex!dysfunction!
Check!segmental!dysfunction!of!cervical!spine!
Correct!with!Origin!&!insertion!technique!or!manipulation!
o If!normal!facilitation!does!not!occur!in!type!II!only!perform!Set!Point!technique!to!area!of!pain!
o If!normal!facilitation!does!not!occur!in!type!III!only!perform!autogenic!facilitation!(muscle!spindle)!
Autogenic!facilitation!facilitates!perform!NSB!technique!
If!autogenic!facilitation!does!not!facilitate!perform!IRT!to!areas!of!past!injuries!

Reciprocal inhibition

Indicated!by!contralateral!upper!and!lower!body!flexor!inhibition!when!tested!simultaneously!(quadriceps!
and!opposite!pec6clavicular)!
Contract!lower!body!flexor!then!check!contralateral!upper!body!flexor!for!facilitation!and!ipsilateral!flexor!for!
inhibition!and!re6facilitation!
o If!inhibition!and!facilitation!pattern!is!dysfunctional:!
Correct!with!IRT!to!one!of!the!following!areas!that!normalizes!the!reciprocal!inhibition!
pattern!in!types!I,!II,!and!III!
Brain,!brain!stem!VRP!area,!spinal!cord!VRP!areas!
If!reciprocal!inhibition!is!still!not!normal!check!the!following!
Insulin!metabolism6pancreas,!HP6endocrine!axis!

Check supraspinatus for unilateral and bilateral inhibition

Bilateral(inhibition:(Non6canalized!system!
Unilateral(inhibition:(Extra!thalamic!cortical!modulating!system6indicated!by!multiple!head!point!TL!

Non-canalized system (usually correct only one of the following)

CNS ATP production pathways
o Anaerobic!pathways!
Brain!CR!TL!facilitates!supraspinatus!(posterior!lateral!C61)!
If!immune!TL!facilitates!consider!bacteria,!virus,!fungus!
o Correct!with!bilateral!maxilla!occiput!tilt!IRT!
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Oxidative!phosphorylation!
Brain!stem!CR!TL!facilitates!supraspinatus!(posterior!tubercle!of!C61)!
Correct!by!treating!visceral!CR!that!facilitates!
Citric!Acid!Cycle!
Heart!CR!TL!facilitates!supraspinatus!
Rebreathing!(always!necessary)!facilitates!supraspinatus!
o Check!and!correct!the!following!that!inhibit!after!rebreathing!facilitates:!
Immune!(T6regulatory!&!B6regulatory,!NFKb)!
Treat!immune!CRs!with!IRT!or!rub!as!indicated!
Thyroid!CR!indicating!GSH!(heavy!metal!metabolism)!
Treat!visceral!CR!that!abolishes!thyroid!CR!TL!
Lung!CR!indicating!fatty!acid!metabolism!
Treat!visceral!CR!that!abolishes!lung!CR!TL!
Cranial!faults!6>!cofactors!(Iron,!Zinc,!CAC!factors)!

Brain insulin metabolism

o Pancreas!CR!TL!facilitates!supraspinatus!
Treat!pancreas!CR!with!occiput!tilt!IRT!
Elevated homocysteine/C-Reactive protein
o TL!to!liver!CR!facilitates!supraspinatus!
Cysteine!facilitates!supraspinatus!
Homocysteine!causes!global!inhibition!
o Treat!liver!CR!with!rub!or!occiput!tilt!IRT!as!indicated!

Extra Thalamic Cortical Modulating System

o

Multiple!head!point!TL!facilitates!unilateral!supraspinatus!
Eye!lateralization!side!to!side!several!times!disrupts!gait!
TL!to!a!single!set!of!head!points!will!normalize!gait!
o Visceral!or!immune!CR!TL!normalizes!gait!indicates!inflammation,!insulin!
dysregulation,!toxic!overload!etc.!!
Treat!involved!CR!with!IRT!or!rub!as!indicated!
o If!visceral!or!immune!CR!does!not!facilitate!treat!involved!head!points!by!
tapping!60690!times!

Pyramidal pattern indicated by:

Ipsilateral!finger!abductors,!wrist!extensors,!shoulder!abductors,!hip!flexors,!great!toe!dorsiflexors,!
supraspinatus!
Correct the pyramidal pattern with one of the following:
o Bilateral!K627!TL!facilitates!indicates!segmental!dysfunction!
Correct!with!segmental!IRT!or!manipulation!
o Thymus!TL!at!upper!sternum!facilitates!indicates!immune!!
T6reg!or!B6reg!facilitates!indicates!autoimmune!
T6reg!or!B6reg!does!not!facilitate!indicates!inflammation!
Correct!with!IRT!to!immune!CR!that!facilitates!
o PTI!facilitates!indicates!one!of!the!following!(oxphos)!
Gonad!CR!TL!indicates!hormone!involvement!
Correct!by!rubbing!or!IRT!to!involved!CR!
Adrenal!CR!TL!indicates!adrenal!hormone!involvement!
Correct!by!rubbing!or!IRT!of!involved!CR!
Pancreas!CR!TL!indicates!dysglycemia!
Correct!by!rubbing!or!IRT!of!involved!CR!
Thyroid!CR!TL!indicates!thyroid!involvement!
Correct!by!rubbing!or!IRT!to!involved!CR!!
o Head!point!TL!indicates!neurotransmitter!dysfunction!
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Correct!by!treating!involved!head!point!
If!none!of!the!above!TL!check!cofactors!for!CAC!!
Correct!with!brain!IRT!

Extremity subluxations
o Test!with!shock!absorber!technique!

Vestibulocerebellar loops
o

Patient!standing!with!eyes!closed!
In!neutral!position!check!axial!flexor!and!extensor!(pec!&!lat)!
In!gait!position!check!disruption!
If!inhibition!and!facilitation!patterns!are!dysfunctional!treat!as!indicated!
o If!rubbing!mastoid!processes!normalizes!treat!with!IRT!
o If!pinching!mastoid!processes!normalizes!treat!segmentally!

Medial and lateral vestibulospinal system

o With!patient!standing!
Forward!bending!then!standing!erect!normally!facilitates!extensors!and!inhibits!flexors!
Neck!flexion!normally!inhibits!extensors!and!facilitates!flexors!
Neck!extension!normally!facilitates!extensors!and!inhibits!flexors!
Lateral!head!tilt!normally!facilitates!ipsilateral!extensors!and!inhibits!contralateral!extensors!
If!inhibition!and!facilitation!patterns!are!dysfunctional!treat!as!indicated!
o If!rubbing!mastoid!processes!normalizes!treat!with!IRT!
o If!pinching!mastoid!processes!normalizes!treat!segmentally!
o If!rubbing!or!pinching!do!not!normalize!perform!fixation!exercises!
Vestibulo-ocular reflex (proceed until VOR challenge is clear)
o VOR!is!tested!with!horizontal,!vertical!and!lateral!head!movement!while!focusing!on!a!stationary!
object!such!as!examiners!finger!
o Perform!VOR!tests!without!eye!convergence!(stimulates!canals6angular!acceleration),!then!perform!
with!focal!point!close!enough!to!converge!eyes!(stimulates!otolith6linear!acceleration)!
Test!each!of!the!above!separately!in!the!neutral!position!then!the!gait!position!
Initially!after!performing!VOR!test!check!supraspinatus!in!the!neutral!position!
o If!supraspinatus!is!inhibited!treat!as!indicated!
If!rubbing!mastoid!processes!normalizes!treat!with!IRT!
If!pinching!mastoid!processes!normalizes!treat!segmentally!
If!rubbing!or!pinching!do!not!normalize!perform!VOR!cancelation!
exercises!
After!clearing!VOR!in!the!neutral!position!perform!VOR!challenge!and!have!the!
patient!step!into!the!gait!position!
o If!gait!is!disrupted!treated!as!indicated!
If!rubbing!mastoid!processes!normalizes!treat!with!IRT!
If!pinching!mastoid!processes!normalizes!treat!segmentally!
If!rubbing!or!pinching!do!not!normalize!perform!VOR!cancelation!
exercises!

Fixation exercises:

Select!a!target!directly!in!front!of!you.!!While!looking!at!the!target!slowly!turn!your!head!from!side!to!side,!
repeat!with!using!head!up!and!down!movements!
Extend!your!hand!out!in!front!of!you!and!use!your!thumb!as!a!target,!move!your!arm!back!and!forth!and!
follow!your!thumb!with!your!eyes!while!keeping!head!stationary!
Combine!head!and!target!movement,!while!moving!your!arm!to!the!left!move!your!head!to!the!right,!go!back!
and!forth!while!keeping!your!eyes!on!your!thumb!

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VOR cancellation exercises:

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Clasp!hands!with!thumbs!up!and!extend!arms,!while!keeping!eyes!focused!on!thumbs!rotate!arms!and!head!
from!the!center!to!the!side!of!the!previously!inhibited!supraspinatus!then!back!to!the!center!

ICAK International Conference 2013, Australia

Metabolic Factors
Glutathione
Cysteine,!Glutamic!Acid,!Glycine!
o If!two!of!three!strengthens:!!
Magnesium,!Potassium,!B66!!
If!Cysteine!strengthens:!
o Magnesium,!B66,!Folic!acid,!B612,!Methyl!donor!
If!Cysteine!strengthens!and!Cystine!weakens:!
B62,!Niacinamide,!Copper!
If!Glutamic!acid!strengthens:!
o B66,!Manganese,!B65,!B62,!B63,!Lipoic!acid!
If!Glycine!strengthens:!
o Folic!acid,!Manganese,!B66,!B62!
Bicarbonate Ion
Zinc,!B66!
Ammonia weakens
B66,!Molybdenum,!Iron,!Manganese,!B65,!Biotin!
Clorox weakens
Magnesium,!Methylcobolamin,!B66,!Folic!acid,!Quercetin,!Antioxidants,!E,!Selenium!
Formaldehyde weakens
Molybdenum,!Selenium,!B62,!B63,!Iron,!E!
EFA metabolism
NSAIDs!strengthens!!prostaglandin!problem!
o EFAs,!B66,!P5P,!Magnesium,!Zinc,!B63!
NSADs!weakens!!elevated!leukotrienes!
o EFSs,!Quercetin,!Zinc!
GAGS
Magnesium,!B612,!Folic!acid,!B66,!Methyl!donors,!Molybdenum,!C,!Iron,!Copper,!Zinc!
Citric Acid Cycle Factors
B61,!B62,!B63,!Manganese,!Lipoic!Acid,!Magnesium!(glycolysis)!
o Electron!Transport!Chain:!
Q10,!Iron,!Copper,!Phosphorous!
Insulin Metabolism
Chromium,!Vanadium,!Lipoic!acid,!Sesame!seed!oil!
Cholesterol
A,!C,!B63,!B65,!Choline,!EFAs,!Lecithin,!Policosanols!
Liver Biotransformation
Folic!acid,!Bioflavonoids!(Silymarin,!Quercetin),!Methyl!donors,!C,!E,!Magnesium,!Manganese,!B62,!B63,!B66,!
Q10,!Molybdenum,!SOD!(Cu,!Mn,!Zn)!
Cytokine Detoxification
Liver!detoxification!nutrients,!especially!Folic!acid,!Manganese,!B62,!B66!(P5P)!
B-6 Metabolism
Magnesium,!Zinc,!Phosphorous,!B62!
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